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General NPI Number Information
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NPI Number | 1508300468
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Entity Type | Individual
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Provider Name | LYNN ELISE VANDYKE RNFA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 1445 SHELDON RD STE G1
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2479
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Country | US
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Telephone | 616-296-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 HILLCREST ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2443
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Country | US
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Telephone | 616-296-9100
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Fax | 616-296-0145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 4704230898
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License Number State | MI
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